Provider Demographics
NPI:1942024120
Name:AUCK, AURIVANE MARIA DE SALES
Entity type:Individual
Prefix:
First Name:AURIVANE
Middle Name:MARIA DE SALES
Last Name:AUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 W QUAIL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5439
Mailing Address - Country:US
Mailing Address - Phone:310-847-0797
Mailing Address - Fax:
Practice Address - Street 1:1555 W QUAIL TRACK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5439
Practice Address - Country:US
Practice Address - Phone:310-847-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ358977224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant